The operative procedure of choice for managing the most common type of choledochal cyst is which of the following?

c. Excision with Roux-en-Y hepaticojejunostomy

The most common choledochal cyst is a type I cyst; 80% to 90% of the total in most reports. These are characterized by fusiform dilation of the choledochus itself. These cysts typically involve the entire common bile duct with only mild dilation of the common hepatic duct and a normal intrahepatic system. The treatment of this lesion is always surgical. Internal drainage procedures without cyst resection (e.g., cyst duodenostomy, cyst gastrostomy and cyst jejunostomy) were routinely performed for type I choledochal cysts until the 1970s. The rate of failure (e.g., stricture, recurrent cholangitis, stone formation, pancreatitis) ranged from 30% to 75%, depending on the length of follow-up and the type of procedure. As these late complication rates became apparent, the risk of bile duct adenocarcinoma in the residual cyst also became widely recognized. Therefore, the preferred operative treatment of a type I choledochal cyst is total transmural excision with Rouxen-Y hepaticojejunostomy. Occasionally, adults with severe inflammation and fibrosis may require intramural cyst dissection, leaving the posteriomedial (outer) wall of the cyst in situ to protect the adjacent portal vein and hepatic artery.